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Updated: Oct 17, 2025
06:41
Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
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Procainamide pharmacokinetics during extracorporeal membrane oxygenation
Nicholas J Vollmer1, Erica D Wittwer2,3, Andrew N Rosenbaum4,5
1Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
Perfusion
|October 7, 2021
Summary
Procainamide dosing during extracorporeal membrane oxygenation (ECMO) is complex. This case suggests N-acetylprocainamide (NAPA) may sequester in ECMO circuits, complicating drug level monitoring for ventricular arrhythmia management.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Cardiology
Background:
- Procainamide is vital for ventricular arrhythmia management.
- Its pharmacokinetics during extracorporeal membrane oxygenation (ECMO) remain poorly understood.
- Accurate dosing is critical for patient outcomes.
Purpose of the Study:
- To investigate the disposition and dosing of procainamide in a patient on venoarterial ECMO.
- To analyze the pharmacokinetics of procainamide and its metabolite N-acetylprocainamide (NAPA).
- To identify challenges in therapeutic drug monitoring during ECMO.
Main Methods:
- Continuous procainamide infusion in a critically ill adult on venoarterial ECMO.
- Pharmacokinetic analysis using serum and urine specimens.
- Assessment of kidney function and N-acetyltransferase 2 genotype.
Main Results:
- Procainamide volume of distribution and half-life were comparable to healthy individuals.
- Elevated serum procainamide but significantly lower NAPA concentrations were observed.
- Hypothesized NAPA sequestration within the ECMO circuit due to concentration discrepancies.
Conclusions:
- Procainamide use during ECMO requires caution and close therapeutic drug monitoring.
- Achieving therapeutic NAPA levels while maintaining safe procainamide concentrations may be challenging.
- Further research is needed to understand drug-ECMO interactions.
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